Download Numbers and Risk A Patient*s Perspective

Numbers and Risk:
A Patient’s Perspective
By Geoffrey Hill
Thelifewelllived.net
Who Am I?
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Parent of Three Special Needs Children
Project Manager for the Census Bureau
Multiple Sclerosis Patient taking Tysabri
Self Confessed Geek
Disclosure of ABIM Service: Geoffrey Hill, MA
 I am a current member of the Internal Medicine Board.
 To protect the integrity of certification, ABIM enforces strict
confidentiality and ownership of exam content.
 As a current member of the Internal Medicine Board, I agree to keep
exam information confidential.
 As is true for any ABIM candidate who has taken an exam
for certification, I have signed the Pledge of Honesty in which
I have agreed to keep ABIM exam content confidential.
 No exam questions will be disclosed in my presentation.
Numbers
• How do we decide what treatment to pursue?
• Doctor’s recommendation
• Friend’s & family experience
• Play the odds
Understanding Numbers:
A Brief Exercise
What is the midpoint between 1 and 9?
- Most people I asked at my work said 4.5 but should have said
5.
- People from cultures where they are not taught to count
mostly say 3.
Why?
Logarithms
• Initially we do not count sequentially.
• Difference between 1 and 2 is not the same as difference
between 9 and 8.
• Perception of difference is based on logarithms.
We Do Not Understand Big
Numbers
• The further we get from 10 or 100, the less we understand.
• How big is the United States’ GDP? 16.4 trillion dollars or 17.4
trillion dollars or 17,400 billion dollars?
• When we talk about taking in 10k Syrian refugees how big an
impact on the problem will our huge sacrifice have on the
problem?
How To Fake It
• Use percent change.
• Compare one large number to another one.
• This is how I justified the risk of Tysabri when I compared the
mortality rate on Tysabri to Chemo.
What Measures and What
Matters
• “Negative Outcomes”
• Is the meaning the same for patients and doctors?
• Are all negative outcomes equal?
• Relative Risks
• What are the risks for the alternatives?
• Not all risks are negative.
• Tracking Risks and Outcomes
• My titer count blood tests give information on risk level.
• Timing of predictive numbers lags my experience.
What Measure?
• How do we measure success or failure?
• Symptoms, change in symptoms, death?
Complex Systems Theory
• Difference between Complicated Systems and Complex
Systems
• Properties of a Complex System
Who Decides?
Who Should?
• FDA
• Doctors
• Insurance
• Patients decide only when empowered by the systems to
which they belong.
Contact Information
• Geoffrey Hill
• Email: [email protected]
• Web Page: Thelifewelllived.net